Question 1

Select the most accurate description of substance dependence.

Accepted Answer

According to the DSM-IV-TR,substance dependence involves lack of control over use as well as tolerance and withdrawal symptoms when intake is reduced or stopped.The distracters describe antagonistic and synergistic effects.

Question 2

When a patient first began using alcohol,two drinks produced relaxation and drowsiness.After 1 year,four drinks are needed to achieve the same response.Why has this change occurred?

Accepted Answer

Tolerance refers to needing higher and higher doses of a drug to produce the desired effect.The potency of the alcohol is stable.Neither hypomagnesemia nor antagonistic effects account for this change.

Question 3

A nurse reviews vital signs for a patient admitted last night with an injury sustained while intoxicated.The medical record shows these blood pressure and pulse readings:
Admission,2 AM - 118/78 mm Hg and 72 beats/min
4 AM - 126/80 mm Hg and 76 beats/min
6 AM - 128/82 mm Hg and 72 beats/min
8 AM - 132/88 mm Hg and 80 beats/min
10 AM - 148/94 mm Hg and 96 beats/min
What is the nurse's priority action?

Accepted Answer

Elevated pulse and blood pressure may indicate impending withdrawal delirium and that additional sedation is warranted.None of the other options takes into account the possible need for sedation.No indication is present that the patient may have a urinary tract infection or is presently in need of restraint.Hydration will not resolve the problem.

Question 4

An attractive nurse worked at a community hospital for several months,resigned,then took a position at another hospital.In the new position,the nurse volunteered to be the medication nurse.Several serious medication errors occurred in rapid succession.Investigation uncovered that the nurse was allowed to resign from the community hospital after diverting patient narcotics for own use.The nurse manager retrospectively identified which early indicator of the nurse's drug use? The nurse:

Accepted Answer

The nurse intent on diverting drugs for personal use usually attempts to isolate self from peers and may manipulate others to gain access to medications.Appearance often deteriorates,and errors are blamed on others.

Question 5

During the third week of treatment,the spouse of a patient in an alcoholism rehabilitation program says,"After this treatment program,I think everything will be all right." Which remark by the nurse will be most helpful to the spouse?

Accepted Answer

During recovery,patients identify and use alternative coping mechanisms to reduce reliance on alcohol.Physical adaptations must occur.Emotional responses,formerly dulled by alcohol,are now fully experienced and may cause considerable anxiety.These changes inevitably have an effect on the spouse and children,who should be given anticipatory guidance and accurate information.

Question 6

A patient asks for information about Alcoholics Anonymous.Select the nurse's best response."Alcoholics Anonymous is a:

Accepted Answer

Alcoholics Anonymous (AA)is a peer support group for recovering alcoholics.Neither professional nor peer leaders are appointed.

Question 7

An alcohol-dependent patient was hospitalized at 4 AM on Saturday.The patient's last drink was at 2 AM.When would the nurse expect withdrawal symptoms to peak then disappear or progress to delirium?

Accepted Answer

Alcohol withdrawal usually begins 6 to 8 hours after cessation or marked reduction of alcohol intake.It peaks between 24 and 48 hours,then resolves or progresses to delirium.

Question 8

Select the most therapeutic manner for a nurse working with a patient beginning treatment for alcohol dependence.

Accepted Answer

Support and empathy assist the patient to feel safe enough to start looking at problems.Counseling during the early stage of treatment needs to be direct,open,and honest.The other approaches will increase patient anxiety and cause the patient to cling to defenses.

Question 9

Which medication to maintain abstinence would most likely be prescribed for patients with either alcoholism or opioid addiction?

Accepted Answer

Naltrexone (ReVia)is useful for treating both opioid and alcohol addiction.An opioid antagonist blocks the action of opioids and the mechanism of reinforcement.It also reduces or eliminates alcohol craving.

Question 10

A patient was admitted last night with a hip fracture sustained while intoxicated.The patient points to the Buck's traction and screams,"Why did you tie me up? Please let me go." The patient is experiencing:

Accepted Answer

The patient is misinterpreting the ropes of the Buck's traction.Illusions are common in early withdrawal from alcohol.A delusion is a fixed false belief.Hallucinations are sensory perceptions occurring in the absence of a stimulus.Codependence is an experience of significant others.

Question 11

A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours.The patient is now shaky,irritable,anxious,diaphoretic,and reports nightmares.The pulse rate is 130 beats/min.The patient shouts,"Bugs are crawling on my bed.I've got to get out of here." Select the most accurate assessment of this situation.The patient:

Accepted Answer

Symptoms of agitation,elevated pulse,and perceptual distortions indicate alcohol-withdrawal delirium,a medical emergency.The findings are inconsistent with manipulative attempts,head injury,or functional psychosis.

Question 12

Police bring a patient to the emergency department after an automobile accident.The patient is ataxic and has slurred speech and mild confusion.The blood alcohol level is 0.4 mg%.Considering the relationship between the behavior and blood alcohol level,which conclusion is most probable? The patient:

Accepted Answer

A nontolerant drinker would be in coma with a blood alcohol level of 0.40 mg%.The fact that the patient is moving and talking shows a discrepancy between blood alcohol level and expected behavior and strongly indicates that the patient's body is tolerant.If disulfiram and alcohol are ingested together,an entirely different clinical picture would result.The blood alcohol level gives no information about ingestion of other drugs.

Question 13

When a patient comes to an outpatient appointment,a nurse smells alcohol.The nurse should:

Accepted Answer

One cannot conduct meaningful therapy with an intoxicated patient.The nurse is setting reasonable limits.The patient should be taken or escorted home and then make another appointment.

Question 14

The treatment team discusses a patient diagnosed with paranoid schizophrenia and cannabis abuse who is having increased hallucinations and delusions.The patient has recently used cannabis on a daily basis.To plan effective treatment,the team should:

Accepted Answer

Both diagnoses should be considered primary and receive simultaneous treatment.Co-occurring disorders require longer treatment and progress is slower,but treatment may occur in the community.

Question 15

An alcohol dependent patient says,"Drinking helps me cope with being a single parent." Which response by the nurse would help the patient conceptualize the drinking more objectively?

Accepted Answer

This response will help the patient see alcohol as a cause of the problems,not a solution.This approach can help the patient become receptive to the possibility of change.The other responses directly confront and attack defenses against anxiety that the patient still needs.They reflect the nurse's frustration with the patient.

Question 16

In the emergency department,a patient's vital signs are: BP 66/40 mm Hg;pulse 140 beats/min;respirations 8 breaths/min and shallow.The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory center secondary to narcotic overdose.Select the priority outcome.

Accepted Answer

This short-term outcome is the only one that relates to the patient's physical condition.It is expected that vital signs will return to normal when the CNS depression is alleviated.The patient's respirations are slow and shallow,but there is no evidence of congestion.

Question 17

A patient admitted to an alcoholism rehabilitation program tells the nurse,"I'm actually a social drinker.I usually have one drink at lunch,two cocktails in the afternoon,wine with dinner,and a few drinks during the evening." Which defense mechanism is evident?

Accepted Answer

Minimizing one's drinking is a form of denial of alcoholism.The patient is more than a social drinker.Projection involves blaming another for one's faults or problems.Rationalization involves making excuses.Introjection involves incorporating a quality of another person or group into one's own personality.

Question 18

A hospitalized,alcohol-dependent patient believes spiders are spinning entrapping webs in the room.The patient is fearful,agitated,and diaphoretic.Which nursing intervention is indicated?

Accepted Answer

One-on-one supervision is necessary to promote physical safety until sedation reduces the patient's feelings of terror.Checks every 15 minutes would not be sufficient to provide for safety.A dimly lit room promotes illusions.Excessive fluid intake can cause overhydration,because fluid retention normally occurs when blood alcohol levels fall.

Question 19

A patient admitted yesterday for injuries sustained while intoxicated believes bugs are crawling on the bed.The patient is anxious,agitated,and diaphoretic.What is the priority nursing diagnosis?

Accepted Answer

The patient's clouded sensorium,sensory perceptual distortions,and poor judgment predispose a risk for injury.Safety is the nurse's priority.The scenario does not provide data to support the other diagnoses.

Question 20

An alcohol-dependent patient admitted yesterday believes the window blinds are snakes trying to get in the room.The patient is anxious,agitated,and diaphoretic.The nurse can anticipate the health care provider will prescribe a:

Accepted Answer

Sedation allows for safe withdrawal from alcohol.Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index and anticonvulsant properties.

Quiz 18: Addictive Disorders